When seeking information on patient care, the first step in doing research is formulating the question you want to answer. Asking well-built clinical questions is one of the fundamental skills of practicing evidence-based medicine (EBM). They make your searches for information more effective and efficient. And, the relevant literature can support patient care decisions with strong evidence and help you facilitate better interaction and communication with patients.
In EBM, one format for formulating your question is called PICO. This framework helps you to identify the key concepts on which you will base your search for clinically relevant evidence in the literature.
The PICO acronym stands for:
P: Patient, population, or problem (description of your patient and issue)
I: Intervention, prognostic factor, or exposure (your plan for the patient’s treatment or intervention)
C: Comparison (alternative interventions if applicable)
O: Outcome (expected results of treatment or intervention)
When type of question and type of study are taken into consideration, you may see the acronym as PICOTT:
T: Type of question (therapy, diagnostic test, prognosis, harm/etiology, prevention, cost effectiveness, quality of life)
T: Type of study (RCT; independent, blind comparison to a gold standard; cohort study; case control, economic analysis, qualitative study)
Start by asking yourself the following questions:
PICO will help you organize your topic into a searchable query. After thoughtful consideration, your question can be structured as such:
In a __________________________ (Patient) with _______________________ (Patient’s condition), is ____________________ (Intervention) as effective as __________________ (Comparison) in ____________________ (Outcome)?
Case Example:
Liz, a 38-year-old patient, is in for her 12-week prenatal appointment. Her blood pressure is slightly elevated; and after reviewing her chart, you note that there is history of preeclampsia in her family. During your discussion on diet and nutrition, Liz reveals that she has problems with dairy so she doesn't drink milk or eat a lot of cheese. With this in mind, you wonder if it would be better to prescribe a calcium supplement instead of low-dose aspirin for prevention of preeclampsia.
Question:
In pregnant women (Patient) with elevated blood pressure and low dairy consumption (Patient’s condition), is a calcium supplement (Intervention) as effective as low-dose aspirin (Comparison) in preventing preeclampsia (Outcome)?
Breaking down your key concepts in this manner will help you better understand whether or not your topic is searchable and your question is answerable. It is also helpful in identifying the terms that you’ll use to formulate your search strategy.
Save or print this worksheet to help formulate your question when doing research:
Once you’ve formulated your question, two additional elements can help you determine the most appropriate articles to look for—type of question and type of study. Knowing the type of question will help you determine the type of study you should look for:
Each type of study will have a level of evidence:
The higher a type of study falls in the hierarchy, the better the evidence it has. Studies at the top include:
No matter what type of question, a systematic review is always better than an individual study.